lantus dosages

  1. 0
    We had a pt recently that was receiving 135 units of Lantus qHS. Is there a maximum amount of Lantus that anyone knows of? The pt was obese (@ 300lb), was still running high BGs (200's) and stated that his DM II is always out of control. Any thoughts, ideas, etc.? This person just got my brain to running and in spite of all the info on here I haven't come across a max dose for Lantus.

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  2. 17 Comments...

  3. 0
    I have heard that the max is 100 units at a time.....but I have also given over 100 units to a few very large patients.

    My grandpa is 400lbs and 6 foot 3.... he takes 100 units twice daily along with his humalog 100 units three times a day with meals..
  4. 0
    I've had pt on amounts that are around 75 units.
  5. 0
    I dont remember the exact dose, but it did exceed 135u lantus on a pt in the hospital I had. He was a large man and this new dosing schedule was the first time for years that his DM II was under control (mostly)
  6. 0
    When I was working at a small community psychiatric hospital about a year and a half ago, one of the chemical dependency patients was an overweight male who took 90 units of Lantus insulin BID. His blood glucose levels tended to trend toward the high side.
  7. 0
    I just got an order on a patient who now takes 82 units Lantus daily, plus sliding scale Humalog. The doc says titrate the Lantus dose upward by 2-4 units Q 5 days until FBG is 80-160. I am worried we will hit the 'overdose' amount and have a hypoglycemic crash. (This is a home health patient, not in hospital.)
  8. 1
    I had a patient that took 175 units qHS. Pharmacy sent it up in a 3ml syringe that we attached a subq needle to. If their blood sugars are still high, it's not too much.
    Last edit by blondy2061h on Jan 9, '11
    osborncs likes this.
  9. 0
    I appreciate your reply. I have started titrating the dose upward, as the doc prescribed. The patient is able to identify signs of low blood sugar, so I think we will be OK.
  10. 0
    I recently had a pt who was on 100 units bid while in the hospital. His home dose was 120 units bid!
  11. 1
    The typical dosing of total daily insulin for an obese pt is 0.6 units/kg/day, so for a 300 lb pt, I'd think they'd start @ about 40 lantus then about 15 or so aspart with meals. That said, that's a base estimate which is titrated up from there as needed, so wow, this person must have really out of control diabetes!

    One thing I've also seen is for bigger people is a divided dose of lantus, say 1/2 at night, 1/2 with lunch or something, which the endocrinologist said was because although lantus was theoretically giving a basal dose over 24 hours, it can be metabolized differently and effectively only cover for say, 20 hrs, so dividing the dose ensures more constant coverage.

    Anyhow, the highest I've seen is 80 U, and the lady could've definitely probably gone up from there b/c her sugars were still 200+. It'd be interesting to see in your case how the dose had been titrated, ie, where did they start and how did they get here? At a certain pt too, I'd start to suspect there's more going on in this case than just 'pt needs more insulin'.
    Start2 likes this.

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